Endoscopic suture systems

ABSTRACT

A surgical instrument for applying sutures to tissue includes a needle deployment mechanism and a catch mechanism. In some embodiments, the needle deployment mechanism employs a linear path. Alternatively, it can employ a curved needle. The surgical instrument may include a rotatable head, a bend, and/or a malleable elongated body member formable into various shapes.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. Ser. No. 11/398,038, filed onApr. 4, 2006, now issued as U.S. Pat. No. 8,382,774, which is acontinuation of U.S. Ser. No. 10/365,277, filed on Feb. 12, 2003, nowissued as U.S. Pat. No. 7,048,749, which is a divisional of U.S. Ser.No. 09/579,455, filed on May 26, 2000, now issued as U.S. Pat. No.6,551,329, which is a divisional of U.S. Ser. No. 09/273,117, filed onMar. 19, 1999, now issued as U.S. Pat. No. 6,096,051, which claims thebenefit of and priority to U.S. Ser. No. 60/078,916, filed on Mar. 20,1998. The entire contents of all of the above-referenced applicationsand patents are incorporated herein by reference.

TECHNICAL FIELD

The invention generally relates to surgical instruments for applyingsutures to tissue. More particularly, the invention relates to needledeployment mechanisms and catch mechanisms.

BACKGROUND INFORMATION

Suturing of body tissue is a time consuming aspect of many surgicalprocedures. For many surgical procedures, it is necessary to make alarge opening in the human body to expose the area that requiressurgical repair. There are instruments available that allow for viewingof certain areas of the human body through a small puncture woundwithout exposing the entire body cavity. These instruments, calledendoscopes, can be used in conjunction with specialized surgicalinstruments to detect, diagnose and repair areas of the body thatpreviously required open surgery to access.

Currently, most surgical instruments used in endoscopic procedures arelimited by the manner in which they access the areas of the human bodyin need of repair. In particular, the instruments may not be able toaccess tissue or organs located deep within the body or that are in someway obstructed. Also, many of the instruments are limited by the waythey grasp tissue, apply a suture, or recapture the needle and suture.In addition, many of the instruments are complicated and expensive touse due to the numerous parts and/or subassemblies required to make themfunction properly.

SUMMARY OF THE INVENTION

The present invention generally is directed to medical instruments forinserting a suture through body tissue in a quick and easy manner usingneedle deployment mechanisms and catch mechanisms. In some embodiments,the needle deployment mechanism employs a linear needle path. In otherembodiments, the needle deployment mechanism employs a curved needlepath. Some embodiments of the needle deployment and catch mechanisminclude a rotatable head.

The instruments of the present invention are useful for application ofsutures to approximate the sides of a tissue wound in; for example,open, mini-incision, trans-vaginal, or endoscopic surgical procedures.These instruments may be used in surgical procedures such as burchcolposuspension, sacrospinous vaginal vault suspension, paravaginalrepair, radical prostatectomy, sub-urethral sling, oopherectomy,myomectomy, nissen fundoplication, cholecystectomy, and urethralanastomosis, for example.

In one aspect, the invention relates to a suturing instrument comprisingan elongated body member, a head, and a needle carrier. The head extendsfrom a distal end of the elongated body member, and the head defines alongitudinal groove and an opening in communication with thelongitudinal groove. The head also includes a needle catch disposedwithin the opening. The needle carrier is for holding a needle, and theneedle carrier is disposed and movable within the longitudinal groove toadvance linearly the needle into the opening and towards the needlecatch.

Embodiments according to this aspect of the invention can include thefollowing features. The needle carrier can define a needle holder and arecess for suture material. The needle carrier can include a U-bend. Theneedle catch can include an opening with at least two flexible edges.The suturing instrument can include a handle located opposite the distalend of the elongated body member, and the handle can include an actuatorcoupled to the needle carrier.

In another aspect, the invention relates to a suturing instrumentcomprising an elongated body member, a needle catch, and a needlecarrier. The needle catch includes at least one opening for receiving aneedle, and the needle catch is movable from within the elongated bodymember to outside of the elongated body member. The needle carrier isfor holding the needle, and the needle carrier is movable from withinthe elongated body member to outside of the elongated body member.

Embodiments according to this aspect of the invention can include thefollowing features. The suturing instrument can include a pusher movablydisposed within the elongated body member and coupled to the needlecarrier and needle catch. The suturing instrument can also include aneedle catch driver coupled to the pusher and the needle catch and/or aneedle carrier driver coupled to the pusher and the needle carrier. Thepusher can move the needle carrier and needle catch from within theelongated body member to outside the elongated body member. The pushercan move the needle carrier and needle catch towards each other, and inone embodiment, the needle carrier and needle catch can intersect. Inaddition, the suturing instrument can include a distal end with an innertaper to direct the needle carrier and needle catch towards each otherwhen moved from within the elongated body member to outside theelongated body member. The needle carrier can include a needle holderand a recess for suture material located it its distal end. The needlecatch can include a point for tissue penetration.

In yet another aspect, the invention relates to a suturing instrumentcomprising an elongated body member, a curved needle, and a pusher. Theelongated body member includes a distal portion and defines a curvedchannel within the distal portion. The curved needle includes a seriesof notches and is receivable within the curved channel. The pusher ismovably disposed within the elongated body member and contacts thenotches of the needle to advance the needle out of the curved channel.

Embodiments according to this aspect of the invention can include thefollowing features. The curved channel and/or the curved needle cancomprise a semi-circular shape. The series of notches disposed on thecurved needle can be located on the needle's concave or convex surface.The suturing instrument can define an opening leading to the curvedchannel and a protruding edge at the opening for engaging the series ofnotches of the needle.

In still another aspect, the invention relates to a suturing instrumentcomprising an elongated body member and a head. The elongated bodymember includes a first engaging element located at its distal end. Thehead includes a second engaging element located at its proximal end thatengages with the first engaging element of the elongated body member toposition the head in one of a plurality of orientations with respect tothe elongated body member.

Embodiments according to this aspect of the invention can include thefollowing features. The first engaging element can include a femaleconfiguration, and the second engaging element can include a maleconfiguration for mating with the first engaging element. Alternatively,the first engaging element can include a male configuration and thesecond engaging element can include a female configuration for matingwith the first engaging element. The female configuration can include aseries of notches and/or a flexible detent for engaging the maleconfiguration, and the male configuration can include a series ofprotuberances, notches, and/or fluted cuts for engaging the femaleconfiguration. The head of the suturing instrument can be secured inposition by engaging the first and second engaging elements, and thehead can be rotated when the first and second engaging elements aredisengaged. Alternatively, the head can be positioned by rotating oneengaging element with respect to the mating engaging element, and inthis configuration the head is secured in place by mechanical engagementof the two engaging elements. The head can be rotated with respect tothe body member in increments as small as 10°. The head can include aneedle deployment mechanism and a catch mechanism located at its distalend, and the distal end can be bullet-shaped to maintain a body lumen ina dilated state.

Additional embodiments according to any of the foregoing aspects of theinvention can include the following features. The elongated body memberof the suturing instrument can be adapted to access remote tissue ororgans within the body. The elongated body member can include a bend orbends. The bend can take the shape of an elbow, a soft curve, a doublecurve, or any other shape suited to access remote organs or tissuewithin the body. The elongated body member can be preshaped andpermanently bent and comprised of sturdy or resilient material. Theelongated body member can also be comprised of a malleable material andthus be bent and shaped to a desired form. The shaping can be donemanually outside the body, or remotely within the body to fit therequired course for the instrument.

In still yet another aspect, the invention relates to a needle catch foruse with a suturing instrument. The needle catch includes at least oneopening for receiving a needle, and the needle catch includes a pointfor tissue penetration. The point can be formed by at least two taperededges. The needle catch can also be bent to include convex and concavesurfaces, and the needle catch can comprise stainless steel.

These and other objects, along with advantages and features of thepresent invention herein disclosed, will become apparent throughreference to the following description of embodiments of the invention,the accompanying drawings, and the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, like reference characters generally refer to the sameparts throughout the different figures. Also, the drawings are not toscale; emphasis instead generally being placed upon illustrating theprinciples of the invention.

FIG. 1A is a top view of the distal end of one embodiment of thesuturing system according to the invention.

FIG. 1B is a side view of the distal end of one embodiment of thesuturing system according to the invention featuring a Z-bend needlecatch.

FIG. 1C is a longitudinal section view of the distal end of oneembodiment of the suturing system according to the invention taken alongline C-C.

FIG. 1D is a side view of an embodiment of a needle and suture for usewith the invention.

FIG. 2A is a schematic representation of one embodiment of the inventionfor suturing transversely positioned tissue.

FIG. 2B is another schematic representation of one embodiment of theinvention for suturing transversely positioned tissue.

FIG. 3A is a section view of the distal end of the suturing system ofthe embodiment shown in FIGS. 2A and 2B in the retracted position.

FIG. 3B is a section view of the distal end of the suturing system ofthe embodiment shown in FIGS. 2A and 2B in the extended position.

FIG. 4 is a perspective view of one embodiment of a needle catch for usewith the suturing system of FIGS. 2 and 3.

FIG. 5A is a longitudinal section view of the distal end of oneembodiment of the suturing system of the invention.

FIG. 5B is a cross-section view of the distal end of one embodiment ofthe suturing system of the invention taken at line B-B.

FIG. 5C is a side view of one embodiment of a needle with suture.

FIG. 5D is a perspective side view of one embodiment of a pusher.

FIGS. 6A-6C are schematic, perspective, side-view representations of oneembodiment of the suturing system of the invention featuring anelbow-shaped, elongated body member with a rotatable head shown invarious rotated positions, but not showing a needle deployment mechanismor a needle catch mechanism.

FIGS. 6D-6F are schematic representations of some details of therotatable head shown in FIGS. 6A-6C and featuring a needle deploymentmechanism, a needle catch mechanism, and the engaging elements.

FIG. 7A is a schematic representation of one embodiment of a suturingsystem of the present invention featuring an elbow-shaped, elongatedbody member with a rotatable suturing head used in connection with agrasper.

FIG. 7B is a schematic representation of one embodiment of a suturingsystem of the present invention showing a sectional view of the grasperin the extended position.

FIG. 7C is a schematic representation of one embodiment of a suturingsystem of the present invention shown located in the urethra andbladder.

DESCRIPTION

In general, the present invention is directed to various improvements ofcomponents and mechanisms of needle deployment systems for suturingdevices, such as those disclosed in U.S. Pat. No. 5,713, 910 to Gordonet al., U.S. Pat. No. 5,578,044 to Gordon et al., U.S. Pat. No.5,575,800 to Gordon, U.S. Pat. No. 5,540,704 to Gordon et al., U.S. Pat.No. 5,458,609 to Gordon et al., and U.S. Pat. No. 5,364,408 to Gordon,all of which are incorporated herein by reference in their entirety.

Referring to FIGS. 1A and 1B, the distal end 10 of one embodiment of asuturing system according to the present invention defines a distallongitudinal groove 12 located at the tip 14 of the distal end 10 andintersecting with the distal wall 16 of an opening 18. The suturingsystem can include a handle located opposite the distal end of theelongated body member. The handle could take a variety of forms, forexample, the handle could be one of the types used with BostonScientific Corporation suturing systems, in particular the Laurus-CapioPush & Catch suturing system. The distal end 10 may be fabricated frommolded or machined plastic material such as polycarbonate orglass-filled polycarbonate. Located within the opening 18 and in a planesubstantially perpendicular to the needle carrier 44 path is a needlecatch 20 having a distal side 22 resting on the floor 24 of the opening18 and a proximal side 26 resting against the proximal wall 28 of theopening 18. Between the two sides 22 and 26, the needle catch 20 forms aconcave bend 30 proximal to side 22 and a convex bend 32 proximal toside 26 forming a Z-like shape. Between the two sides 22 and 26 of theneedle catch 20 and aligned with the distal longitudinal groove 12 is anopening 34 formed by two flexible edges 36 and a mouth 38. The lateralsides 40 of the needle catch 20 wrap around the distal end 10 of thesuturing system and are secured in place by notches 42 turned inwardinto the body of the distal end, or alternatively into small grooves.The needle catch 20 is preferably made of thin stainless steel material,in particular, high temper stainless steel. The needle catch may bemanufactured by stamping, laser machining or chemical etching, forexample.

Referring to FIG. 1C, in the longitudinal groove 12 is positioned aneedle carrier 44 having a convex U-bend 46. At the end 48 of the needlecarrier is a needle holder 50 that defines a hole with a recess 52 forlodging the needle 54 and suture 56. When the needle carrier 44 isactuated along the longitudinal axis of the elongated body member, theneedle carrier 44 advances the needle 54 linearly from the distal end ofthe longitudinal groove 12, through the tissue located within theopening 18, and into the needle catch 20. The release of the needle 54from the needle carrier 44 occurs upon reverse motion of the needlecarrier 44.

Referring to FIG. 1D, suitable needles 54 for positioning into theneedle holder 50, include a neck 58 with a hole at one of its ends forinserting a suture 56 and at least one shoulder 60. The body 62 of theneedle 54 is tapered from the shoulder 60 to the point 64 to facilitatetissue penetration and insertion into the opening 34 of the needle catch20. The shoulders 60 are made of larger dimensions than the opening 34of the needle catch 20. During insertion of the needle 54 into theopening 34 of the needle catch 20, the edges 36 of the opening 34 flexupon pressure exerted by the body 62 of the needle 54 at the shoulders60 and permit entry of the needle 54 into the opening 34. The needle 54is retained within the needle catch 20 when the edges 36 return to theiroriginal position once the shoulders 60 have entered the opening 34 andthe neck 58 of the needle 54 is lodged in the opening 34. Preferably,the neck 58 has smaller dimensions than the opening 34 to permit theedges 36 to return to their original position. The needle 54 is releasedfrom the needle catch 20 by sliding the neck 58 of the needle 54 towardthe mouth 38 of the opening 34. The dimensions of the mouth 38 arelarger than the dimensions of the shoulders 60 to permit the release ofthe needle 54 from the needle catch 20.

Needle deployment/catch systems as described in FIGS. 1A-1C can be madewith various dimensions as necessary for a specific application. Inparticular, this instrument is well suited to being made to minutedimensions. For example, suitable dimensions to use for a instrument forperforming an urethral anastomosis can be as follows: the tip 14 may be1.15 in. long, 0.205 inch wide, and 0.275 in. high; the distal end 10may be 0.058 in. in diameter; the needle carrier 44 may be 0.032 in. indiameter; the distance between the distal wall 16 of the opening 18 tothe opening 30 of the needle catch 20 may be 0.15 in. long.

One advantage of the suturing system/instrument of FIGS. 1A-1D is thatit requites fewer parts; thereby, making it easier and less expensive tomanufacture than known devices.

Referring to FIGS. 2A and 2B, in another embodiment of the suturinginstrument 66 according to the present invention, the instrument isconfigured to deploy a needle 54 through tissue 68 positionedsubstantially perpendicular to the elongated body member 82 of thesuturing instrument 66. The suturing instrument comprises a pusher 72having a knob 74 at the proximal end and an elongated portion 76extending from the knob 74 to the distal end and connected to the needlecarrier driver 78 and the needle catch driver 80. The elongated portion76 of the pusher 72 is positioned within an elongated body member 82,which includes a tubular body 70 that extends from the proximal end tothe distal end where it contacts the tissue 68 to be sutured. Theelongated body member 82 includes a handle portion 84 located at theproximal end that provides grip for manipulation of the instrument andsupport for actuating the pusher 72.

In the retracted position, as shown in FIG. 2A, the tissue 68 to besutured is positioned at the distal end of, and substantiallyperpendicular to, the elongated body member 82. The needle carrier 44and the needle catch 20 are positioned within the elongated body member82, and the knob 76 is afar from the handle portion 84 of the elongatedbody member 82. In an extended position, as shown in FIG. 2B, the needlecarrier 44 holding a needle 54 and the needle catch 20 are moved to aposition outside the elongated body member 82 and into the tissue 68.The needle carrier 44 and the needle catch 22 can be movedsimultaneously by the needle carrier driver 78 and the needle catchdriver 80 when actuated by the pusher 72. The needle carrier 44 and theneedle catch 22 meet afar from the distal end of the elongated bodymember and into the tissue 68 such that the needle 54 with a suture 56attached thereto is pushed through the opening 34 of the needle catch 20until the shoulders 60 of the needle 54 snap there through. In theextended position, the knob 74 of the pusher 72 is proximal to, and incontact with, the handle 84 of the elongated body member 82. The suture56 and the needle 54 are brought back out of the tissue 68 with theneedle catch 20 when the suturing system is returned to its retractedposition. To facilitate return to the retracted position, the knob 74 ofthe pusher 72 may alternatively comprise a ring for insertion of afinger by the operator of the instrument.

Referring to FIGS. 3A and 3B; showing a longitudinal section of thedistal end of a particular embodiment of a suturing instrument 66, theinterior wall 86 of the elongated body member 82 tapers inward at thedistal end. When the pusher 72 is depressed, moving from afar towardsthe handle 84, the elongated portion of the pusher 72 pushessimultaneously the needle carrier driver 78 and the needle catch driver80 towards their extended position. The tapered interior wall 86 directsboth, the needle carrier 44 and the needle catch 20 towards each otherwhen pusher 72 is depressed.

Alternatively, the needle carrier driver 78 and needle catch 80 can beprebent or include a pivotal system such as a pivot pin or scissors sothat the paths of the needle carrier 44 and the catch 20 run fromseparated lateral positions within the elongated body member 82 to anintersecting point outside the elongated body member 82. In the fullyextended position, shown in FIG. 3B, the needle 54 has been pushedthrough the opening 34 of the needle catch 20 within the tissue 68 to besutured. When the suturing instrument 66 is returned to its retractedposition, as shown in FIG. 3A, the needle 54 is retained by the needlecatch 20 and drawn out of the tissue 68. The needle 54 can then bereleased from the needle catch 20 by pulling the needle 54 and cuttingthe suture 56 off.

A needle catch 20, suitable for use in the suturing instrument 66 shownin FIGS. 2A and 2B, is shown in FIG. 4. The needle catch 20 ispreferably made of a sheet of stainless steel which is bent to provide aconcave surface 88 and a convex surface 90 for rigidity. The needlecatch 20 can contain several openings 34. The needle catch 20 alsocomprises two tapered sides 92 that merge into a point 94 for easypenetration of tissue 68. The needle catch 20 can be mounted and securedto the needle catch driver 80 either by permanent bond using glue or anyknown interlocking system such as pressure snap-in.

Referring to FIGS. 5A-5D, in another embodiment of the invention thesuturing instrument includes an elongated body member 82 having achannel 96 extending from the head portion to the distal end. FIG. 5Ashows a longitudinal sectional view of the distal end of the suturinginstrument 66 with the distal end of channel 96 intersectingtangentially with a curved guiding channel 98. The guiding channel 98 ispositioned along the longitudinal axis of the elongated body member 82and defines two openings 100, 102 on the lateral side of the elongatedbody member 82. The proximate opening 100 permits ingress of a needle104 (shown in FIG. 5C) having a curved shape and a series of notches 106on a portion of the convex surface 108. The point 110 of the needlehaving smooth surfaces and being tapered to facilitate penetration oftissue 68. The tail 112 of the needle 104 having a hole to permitfixation of the suture material 56.

Referring to FIGS. 5A and 5B, a pusher 114 is positioned in thelongitudinal channel 96 with the head 116 forming an edge to providesupport and engage into the notches 106 of the needle 104 introducedinto the guiding channel 98.

On the outer wall 118 of the distal opening 102 is positioned aprotruding edge 120 that provides for locking of the needle 104 duringegress from the guiding channel 98. Each push of the pusher 114 movesthe needle 104 within the guiding channel 98 from the proximal opening100 to the distal opening 102 until a notch 106 locks onto theprotruding edge 120. A pull of the pusher 114 slides the head 116 of thepusher 114 against the sliding sides of the notches 106 until it engagesin a notch 106 closer to the tail 112 of the needle. The push and pullmotion is repeated several times until all of the needle 104 has passedthrough the guiding channel 98, and into tissue positioned parallel to,and in contact with, the distal opening 102. The needle 104 can then beextracted from the tissue once the point 110 resurfaces out of the massof the tissue with surgical pliers, tweezers, hemostats, needle holders,or other appropriate surgical instrument.

FIG. 5B shows a cross-sectional view of the distal end of the suturinginstrument at the intersection between the longitudinal channel 96 andthe guiding channel 98.

FIG. 5D shows a prospective view of the pusher 114 with the head 116.

In yet another embodiment, the instrument can be adapted to facilitateaccess into the abdominal cavity and the placement of suture(s) radiallyin a body lumen. Such instrument may be particularly useful whereanastomosis is required such as urethral anastomosis following radicalprostatectomy or in blood vessel or bowel anastomosis. Referring toFIGS. 6A-6C, the suturing instrument 66 includes an elongated bodymember 82 and a rotatable head 124. The elongated body member 82 caninclude an elbow 122 (or bend). The head 124 rotates by angularincrements. The elongated body member 82 includes an engaging elementlocated at its distal end 128. The head 124 includes an engaging elementlocated at its proximal end 126 for mating with the engaging element ofthe elongated body member 82. The head 124 includes a dilator cap or abullet-shaped end at the distal end 130 of the head 124 to maintain theurethra or any body lumen in a dilated configuration. The rotation ofthe head 124 is performed manually between each application of a suturein a body lumen and before reloading with the needle and suture topermit application of a series of sutures along the circumference of thelumen, at incremental angular positions that can be as small as 10°. Theembodiment of the suturing instrument featuring an elbow and rotatablehead is particularly adapted to perform suturing after removal of theprostate to connect the bladder to the urethra or generally followingany other type of resection.

In one embodiment, the rotatability of the head 124 is accomplished withthe structure depicted in FIGS. 6D-6F. The head 124 includes an engagingelement with a male configuration 123. The male configuration 123includes a series of fluted cuts 133 located along 330° of itsperimeter. The male configuration 123 includes a stop to prevent thehead from rotating 360°. The elongated body member 82 includes anengaging element with a female configuration 125 and a flexible detent131. The female configuration 125 is a substantially circular recesswith the flexible detent mounted within the elongated body member 82 andprotruding into the substantially circular recess. The flexible detent131 can be a length of spring wire or a pin, and can be made of nitinol.The head 124 can be positioned by rotating the male configuration 123engaging element with respect to the female configuration 125 engagingelement, deflecting the flexible detent 131, and then allowing theflexible detent 131 to mechanically engage the fluted cut 133 whichcorresponds to the desired angular orientation. The head can bepositioned in angular increments of 30°. In addition, the head 124depicted in FIGS. 6D-6F includes a needle deployment mechanism 127 and aneedle catch mechanism 129.

Referring to FIGS. 7A-7C, to further facilitate positioning of theinstrument within the body passageway, a grasper device 132 may beintroduced into the body cavity by a second point of entry. The grasperdevice comprises a hollow elongated body member 134 for housing a pairof spring-loaded jaws or tweezers 136 at the distal end of the bodymember 134. The tweezers 136 are close together in a retracted positionas shown in FIG. 7A and open to permit grasping of the knob 138 locatedon the distal end of the head 124 in an extended position as shown inFIG. 7B. When closed around the ball or knob 138, the grasping tweezers136 can allow rotatable movement of the knob 138 and thus rotation ofthe head 124.

The proximal end of the grasper device 132 features a button 140 that ispositioned at the proximal end of a wire 142. The wire 142 is connectedto the tweezers 136 at the distal end. The device is maintained in theretracted position by a spring 144 located in the head 146 of thegrasper 132 which rests its proximal end against the button 140 and itsdistal end against a protuberance 148 positioned in the interior wall ofthe head 146.

FIG. 7C shows both the grasper 132 and the suturing instrument 66located in the urethra 150 and the bladder 152 below the public bone 154of a male following prostatectomy. The void left by the removed prostateis addressed by using the instrument 66 together with the grasper 132 toinsert sutures all around the end of the urethra 150 to join it to thebladder 152.

In yet other embodiments of the instant invention, the aforementionedsuturing systems can be used to deploy an anchor or fastener that is toremain in the tissue. Such anchor or fastener may be; for example, abarbed needle, a metal clip, or a staple.

Having described embodiments of the invention, it will be apparent toone skilled in the art that other embodiments incorporating the conceptsdisclosed herein may be used without departing from the spirit of theinvention. Thus, numerous other embodiments include, but are not limitedto: changes in the dimensions of the instruments; the type of materialsemployed; the location and type of needle, anchor or fastener; andneedle loading mechanisms. All are within the scope of the presentinvention. The described embodiments are to be considered in allrespects only as illustrative and not restrictive. Therefore, it isintended that the scope of the present invention be only limited by thefollowing claims.

What is claimed is:
 1. A suturing instrument, comprising: a handle; anelongate body member distally extending from the handle; a distalportion including an opening and extending distally from and fixed tothe elongate body member such that the distal portion does not move withrespect to the elongate body member; a suture; a suture holder forholding the suture; a pointed member having a closed slot definedtherein, the closed slot being configured to capture the suture and pullthe suture from the suture holder; and a needle deployment systemconfigured for deploying the pointed member and the suture holderbetween an extended position with the pointed member and the sutureholder extending distally out of the opening and into a tissue and aretracted position with the pointed member and the suture holder pulledout of the tissue and back into the opening, wherein the pointed memberand the suture holder are deflected toward each other as they aredeployed from the retracted position to the extended position such thatthe suture passes through the closed slot, the closed slot, while thepointed member is extended and deflected, is configured to capture thesuture from the extended and deflected suture holder and pull the suturethrough the tissue and into the opening as the pointed member is pulledback into the refracted position.
 2. The suturing instrument of claim 1,wherein the opening is open in a distal direction from the elongate bodymember.
 3. The suturing instrument of claim 1, wherein the needledeployment system comprises an actuator for deploying the pointed memberand the suture holder.
 4. The suturing instrument of claim 3, whereinthe actuator is at least partially disposed within the handle.
 5. Thesuturing instrument of claim 1, wherein the pointed member is bent so asto define a convex surface and an opposing concave surface.
 6. Thesuturing instrument of claim 1, wherein a distal end of the elongatemember includes an inner taper that causes the suture holder and thepointed member to move toward each other when moved from the retractedposition to the extended position.
 7. The suturing instrument of claim1, wherein, when in the extended position, the suture holder and thepointed member intersect.
 8. A suturing instrument, comprising: ahandle; an elongate body member distally extending from the handle; aneedle carrier disposed at a distal end of the elongate body member; aneedle catch disposed at the distal end of the elongate body member, theneedle catch having a slot defined therein; a needle attached to an endof a suture, the needle being disposed in a recess of the needlecarrier; and a needle deployment system configured to move the needlecarrier and the needle catch, with respect to the elongate body member,between a proximally retracted position and a distally extendedposition, wherein the needle carrier and needle catch are deflectedtoward each other as they are deployed from the proximally retractedposition to the distally extended position, such that the needle and atleast a portion of the needle carrier pass through the slot, the slotbeing configured to capture the needle from the needle carrier when theneedle catch and the needle carrier are extended and deflected andconfigured to pull the needle out of the needle carrier as the needlecatch is moved from the distally extended position to the proximallyretracted position.
 9. The suturing instrument of claim 8, wherein theneedle deployment system comprises an actuator for deploying the needlecatch and the needle carrier.
 10. The suturing instrument of claim 8,wherein the needle catch is bent so as to define a convex surface and anopposing concave surface.
 11. The suturing instrument of claim 8,wherein the distal end of the elongate body member includes an innertaper that causes the needle carrier and the needle catch to move towardeach other when moved from the retracted position to the extendedposition.
 12. The suturing instrument of claim 8, wherein, when in theextended position, the needle carrier and the needle catch intersect.